Unbundled Services Payment Option Advances and More ADHC Updates

Update: Unbundled Services Payment Option (USPO)

The unbundled services payment option, which amends Adult Day Health Care (ADHC) regulations Part 425 and allows greater flexibilty for ADHC programs that contract with Managed Long Term Care (MLTC) plans, passed through the Public Health and Health Planning Council (PHHPC) codes committee last week. The USPO, otherwise known as the hybrid option, may be approved by the full PHHPC as early as Aug. 7. This is sooner than expected and great news for ADHC programs that have been waiting for the changes in regulation. The Adult Day Health Care Council (ADHCC) will keep members apprised of new developments. For more information on the USPO, click here.

Transitional Care Policy/Transition Period for ADHC as a covered service under MMC extended through Jan. 31, 2015

Last week, the ADHCC was advised by the Department of Health (DOH) that the transition year for covering ADHC under Mainstream Managed Care (MMC) would be extended beyond July 31, 2014 through Jan. 31, 2015.

As members are aware, ADHC became a benefit under MMC in August 2013. Effective Aug. 1, 2013, ADHC programs began billing MMC plans and discontinued billing Medicaid Fee-For-Service (FFS) for ADHC services.

The transition to MMC does not apply to ADHC registrants who are enrolled in the Nursing Home Transition and Diversion (NHTD) waiver, the Traumatic Brain Injury (TBI) waiver or a waiver/program operated by the Office of People with Developmental Disabilities (OPWDD). These individuals will NOT be enrolled in an MMC. ADHC for these individuals will continue to be provided on a FFS basis until further notice.

Click here to read the entire memo on the extension of the transition period.

Save the Date!

The ADHCC annual membership meeting will be held at the LeadingAge NY/ADHCC offices on Thurs., Sept. 11. This meeting will run from 11 a.m. to 3 p.m. and include a presentation on the grievance and appeals process in managed care. A formal announcement and registration form will be emailed shortly.